<div class="title">{ %lang e32 }</div>
<form action=""  method="post">
<table cellpadding="4" cellspacing="4">
<tr><td>{ %lang e10 }</td> <td><input type="text" name="email" size="30" ></td>  </tr>
<tr><td>{ %lang e36 }</td> <td><img src="{ #imageurl }" border="0" ><br><input type="text" name="check" size="30" /> </td>  </tr>
<tr><td align="center" ><input style="font-weight:bold;" type="Submit" name="PasswordSubmit" value="{ %lang e40 }" > </td></tr>
</table>
</form>
